Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) This act shall be known and may be cited as the "Connecticut Health Care Security Act".
Sec. 2. (NEW) There shall be a Connecticut Health Care Trust, referred to in this act as "the trust", in the Department of Social Services. The trust shall not be subject to the supervision or control of said department or of any board, bureau, department or other agency of this state, except as specifically provided by this act.
Sec. 3. (NEW) The Connecticut Health Care Trust shall have the following powers:
(1) To make, amend and repeal by-laws, rules and regulations for the management of its affairs;
(2) To adopt an official seal;
(3) To sue and be sued in its own name;
(4) To make contracts and execute all instruments necessary or convenient to carry out the purposes of said trust;
(5) To acquire, own, hold, dispose of and encumber personal, real or intellectual property of any nature or any interest therein;
(6) To enter into agreements or transactions with any federal, state or municipal agency or other public institution or with any private individual, partnership, firm, corporation, association or other entity;
(7) To appear on its own behalf before boards, commissions, departments or other agencies of federal, state or municipal government;
(8) To appoint officers and to engage and hire employees, including legal counsel, consultants, agents and advisors and prescribe their duties and fix their compensation;
(9) To establish advisory boards;
(10) To procure insurance against any losses in connection with property of the trust in such amounts and from such insurers, as may be necessary or desirable;
(11) To invest any funds held in reserves or sinking funds, or any funds not required for immediate disbursement, in such investments as may be lawful for fiduciaries in the state of Connecticut;
(12) To accept, hold, use, apply and dispose of any and all donations, grants, bequests and devises, conditional or otherwise, of money, property, services or other things of value which may be received from the United States, the State of Connecticut, any agency of the United States or any other governmental agency, institution, person, firm or corporation, whether public or private. Such donations, grants, bequests and devises shall be held, used, applied or disposed of for any or all of the purposes specified in this act and in accordance with the terms and conditions of any such donation, grant, request or devise. The trust shall detail receipt of each such donation, grant, request or devise in the annual report of the trust, which shall include the amount and the identity of the donor and the lender, the nature of the transaction and any conditions attached to the donation or grant;
(13) To set or establish methods for setting rates, fees and prices for the Connecticut health care system and reviewing the sufficiency of such rates, fees and prices;
(14) To establish timely and simplified reimbursement systems for the Connecticut health care system;
(15) To establish standards of care and staffing for the Connecticut health care system;
(16) To establish health care guidelines for the treatment and prevention of specific illnesses under the Connecticut health care system;
(17) To review health care providers based on the guidelines established in subdivision of this section; (18) To certify, license and recertify all health care providers and health care service organizations including hospitals, nursing homes, medical laboratories, residential treatment centers, health care clinics, and any and all other health care service organizations;
(19) To ensure that all existing laws regarding patient confidentiality are enforced;
(20) To approve or reject any health care capital expenditure by the Connecticut health care system in excess of five hundred thousand dollars;
(22) To arbitrate grievances arising under the Connecticut health care system;
(22) To establish an enrollment system for all persons eligible to participate in the Connecticut health care system;
(23) To establish a formula for and develop global health care budgets and other system budgets for the Connecticut health care system;
(24) To use bulk purchasing power to lower costs of the Connecticut health care system;
(25) To adopt a medical benefits package for the Connecticut health care system;
(26) To establish and fund the trust's administrative structure;
(27) To administer Connecticut Health Care Trust revenues;
(28) To recommend, in conjunction with the Department of Revenue Services and subject to the approval of the General Assembly, the imposition of taxes to fund the trust;
(29) To negotiate the transfer of funds from this state and the federal government for health care and administrative duties previously performed by these governments and transferred to the trust;
(30) To administer funds to support the trust; (31) To institute global budgets for health care institutions; (32) To institute, administer and carry out all statutes related to health care for the State of Connecticut. (33) To do any and all other things necessary and convenient to carry out the purposes of this act;
Sec. 4. (NEW) (a) The Connecticut Health Care Trust shall be governed by a thirty member board of trustees appointed as follows: One member shall be the Commissioner of Social Services; one member shall be the Commissioner of Revenue Services; one member shall be the Commissioner of the Connecticut Department of Veteran’s Affairs, one member shall be the State Treasurer, one member shall be the executive director of the trust as per Sec. 5 of this act, one member shall be the chairperson of the consumer advisory council as per Sec. 11 of this act, one member shall be the chairperson of the professional advisory board as per Sec. 12 of this act, one member shall be the chairperson of the health care organization advisory board as per Sec. 13 of this act, two members shall be the chairpersons of the joint standing committee of the General Assembly having cognizance of matters relating to public health and twenty members shall be appointed by or subject to the approval of the Governor, one of whom shall represent state-wide organizations of Connecticut senior citizens, one of whom shall represent state-wide organizations that defend the rights of children, one of whom shall represent state-wide organizations that defend the rights of low income clients, one of whom shall represent state-wide organizations that defend the rights of minorities, one of whom shall represent state-wide labor organizations, one of whom shall represent state-wide organizations that defend the rights of the disabled and mentally retarded, one of who shall represent state-wide organizations that advocate for the mentally ill, one of whom shall represent state-wide health care labor organizations, one of whom shall be a health care economist selected from nominations by universities situated in the State of Connecticut, one of whom shall represent the Connecticut State Medical Society, one of whom shall represent the Connecticut Nurses Association, one of whom shall represent state-wide organizations of mental health care providers, one of whom shall represent the Connecticut Pharmacy Association, one of whom shall represent the Connecticut State Dental Association, one of whom shall represent state-wide organizations of otherwise not represented licensed health care providers in Connecticut, one of whom shall represent the Connecticut Hospital Association, one of whom shall represent state-wide organizations of non-hospital health care facilities including residential treatment centers, nursing homes, and long term care centers, one of whom shall represent the Connecticut Business and Industry Association, one of whom shall represent state-wide organizations of small businesses and one of whom shall represent state-wide organizations of the self-employed. The representatives of the Connecticut State Medical Society, the Connecticut Nurses Association, the Connecticut Pharmacy Association, the Connecticut State Dental Association, the Connecticut Hospital Association, and the Connecticut Business and Industry Association shall be selected by their respective organizations and serve on the board subject to the approval of the Governor. The Governor shall make the remaining representative appointments to the board from nominations submitted by relevant state organizations. Such organizations shall submit one nomination to the Governor not later than one month after the effective date of this act, or not later than one month after a vacancy on the board due to resignation, removal or completion of term. If there are not three such qualifying organizations, these organizations shall meet so that there shall be at least three nominations for each appointment. The Governor shall make appointments from the list of nominations not later than two months after receiving said list.
(b) Each member shall serve a term of five years, except that for the initial appointments, six members shall serve three-year terms, seven members shall serve four-year terms and seven members shall serve five-year terms. The governor shall determine the length of the particular initial appointments within the designated distribution of terms. Any person appointed to fill a vacancy on the board shall serve the unexpired portion of the vacated term. Any trustee shall be eligible for reappointment. The Governor may remove any trustee for cause.
(c) Fifteen trustees shall constitute a quorum and the affirmative vote of a majority of the trustees present and eligible to vote at a meeting shall be necessary for any action to be taken by the board. The board of trustees shall meet at least four times each year and have final authority over the activities of the trust. The Commissioner of Social Services shall serve as chairperson. The gubernatorial and advisory council appointees shall annually elect a vice chairperson from among themselves. The trustees shall serve without compensation by the Trust, but shall be reimbursed for actual and necessary expenses incurred in the performance of their duties. Trustees may be compensated for their work on the board by the state-wide organizations they represent at the discretion of those organizations.
Sec. 5. (NEW) (a) The board of trustees shall hire a Connecticut licensed physician with a tangible record of commitment to single-payer universal health care to serve as the executive director of the trust and serve on the board of trustees. The executive director shall be the executive and administrative head of the Connecticut Health Care Trust and shall be responsible for administering and enforcing all provisions of law relating to the trust.
(b) The executive director may, as said director deems necessary for the effective administration and proper performance of the duties of the trust and subject to the approval of the board of trustees:
(1) Adopt, amend, alter, repeal and enforce all reasonable rules, regulations and orders as may be necessary to carry out the provisions of this act; and
(2) Appoint and remove employees and consultants, provided at least one employee shall be hired to serve as director of each of the divisions of the trust created by this act, subject to the availability of funds in the trust.
(c) The executive director, in consultation with the directors of each division of the trust, shall:
(1) Negotiate or establish terms and conditions for the provision of health care services and rates of reimbursement for such services on behalf of Connecticut residents, which terms shall include provisions to assure that Connecticut residents are entitled to use their health insurance benefits in other states and countries for acute care while visiting such other states and countries;
(2) Negotiate or establish manufacturer discounts and rebates for covered prescription drugs and other health care products;
(3) Develop prospective and retrospective reimbursement systems for covered services to provide prompt and fair payment to eligible providers;
(4) Oversee preparation of annual operating and capital budgets for the state-wide delivery of health care services in accordance with the budgetary constraints provided in section 16 of this act and with the constraint that any increases in the budget of the trust shall not exceed any percentage increase in national health care spending for the preceding year starting five years after the first trust budget;
(5) Oversee preparation of annual benefits reviews to determine the adequacy of covered services; and
(6) In collaboration with the Department of Revenue Services and Governor, subject to the approval of the General Assembly, establish alterations in the methods of payment for the Connecticut Health Care Trust provided such changes are consistent with the guidelines established by this act.
Sec. 6. (NEW) (a) There shall be a planning, development and research division of the Connecticut Health Care Trust which shall be under the supervision of a director. The director of the division of planning, development and research shall be appointed by the executive director with the approval of the board of trustees, and may be removed by the executive director with the approval of said board.
(b) Subject to the direction, control and supervision of the executive director, the director of planning, development and research shall be responsible for:
(1) Recommending to the executive director, in conjunction with the consumer, professional and health care organization advisory councils, a standard benefits package which shall include (A) diagnostic tests, treatments, including, but not limited to, mental health services, general medical services, emergency medical care, hemodialysis, midwifery and pediatric services, medicinals and durable medical equipment prescribed by licensed health care providers, (B) preventive and rehabilitative services, (C) inpatient, partial hospitalization and residential treatment services for medical and mental health disorders, (D) hospice care, (E) home-based and office-based services by individual providers, (F) long-term care and treatment, (G) prenatal, perinatal and maternity care, family planning, fertility and reproductive health care, (H) dental care, (I) disability evaluations and (J) care provided by any and all other licensed health care providers in the State of Connecticut. The director of planning, development and research shall review and update the benefits package on an annual basis.
(2) Recommending to the executive director, after consultation and negotiation with the professional, health care and consumer advisory councils, fees for providers covering all billable procedures. Such fees shall not be less than standard federal Medicare fees for providers in the state of Connecticut and shall be renegotiated on an annual basis.
(3) Recommending to the executive director, in consultation with the professional advisory council, guidelines for the treatment and prevention of medical and mental illnesses.
(4) Following negotiations with the health care organizations and consumer advisory councils, recommending to the executive director fees for health care facilities. In recommending such fees, the director shall give consideration to establishing capitated global operating budgets and prospective payment mechanisms for all free-standing health care facilities that provide other than outpatient services for Connecticut residents. If prospective payment schedules are developed, the trust shall provide for retrospective adjustment of payments to eligible health care facilities. Such payments shall be adjusted yearly.
(5) In consultation with the consumer, health care organizations and professional advisory councils, recommending an annual operating budget, with the understanding that any increases in the budget shall not exceed any percentage increase in national expenditures for health care for the preceding year starting five years after the first budget and shall conform to the budgetary constraints provided in section 16 of this act.
(6) Making recommendations as to how the annual global operating budget shall be funded from the following sources: (A) Money transferred to the trust equivalent to the funds the state would have paid to provide health care, including administrative expenses, to Connecticut residents under Title XIX and Title XXI of the Social Security Act plus those functions of current state agencies and programs assumed by the trust as delineated in Section 17 of the Act as well as money that would have been used to pay for health care insurance premiums for current or former state employees and their families if this Act had not been put into effect, (B) money transferred to the trust from the federal government that would have been used to pay Medicare, Title XIX , Title XXI or other health care costs, including Veteran’s health care benefits, for Connecticut residents, as well as money which would have been used to pay for the health care insurance premiums for federal employees had this Act not been put into effect, (C) gifts, grants and donations, (D) copayments from outpatient provider visits, (E) taxes on any and all items which have been or can be shown to contribute to illness or cause medical injury requiring treatment such as tobacco products, alcohol, gasoline, firearms, motor vehicles and air or water polluting businesses or , (F) a health care payroll tax, (G) a health care insurance income tax, (H) investments, (I) unutilized money from the tobacco settlement, and (J) general appropriations transferred to the trust by the General Assembly in response to requests from the executive director of the trust.
(7) In consultation with the consumer, professional and health care organizations advisory councils, making recommendations concerning current and future health needs by studying under-utilization and over-utilization of the state health system in various parts of the state, unnecessary duplication of services, outcome measurements of treatment, the need for, or overabundance of, particular types of health care workers in particular areas of the state, needed capital expenses and the best means to prevent and treat disease in consultation with the consumer, professional and health care organizations advisory councils.
(8) Recommending research-based changes in the Connecticut health care system to the executive director and delineating the cost of such recommended changes.
(9) Assisting and coordinating research efforts with the trust’s division of quality assurance in efforts to evaluate the efficacy of health care providers or health care institutions, as well as their overall compliance with treatment guidelines developed by the trust’s division of planning, development and research.
Sec. 7. (NEW) (a) There shall be a benefits division of the Connecticut Health Care Trust which shall be under the supervision of a director. The executive director, with the approval of the board of trustees, shall appoint the director of the benefits division of the trust. The executive director may, with like approval, remove said director.
(b) The director of the benefits division shall be responsible for:
(1) In consultation with the consumer, professional and health care organizations advisory councils, making prompt payments to providers for covered services;
(2) In conjunction with the director of the division of quality assurance and the director of the division of planning, development and research and in consultation with the consumer, professional and health care organizations advisory councils, developing information management systems necessary for provider payment and utilization review; and
(3) In consultation with the consumer advisory council, investing trust fund assets consistent with state law.
Sec. 8. (NEW) (a) There shall be a quality assurance division within the Connecticut Health Care Trust which shall be under the supervision and control of a director. The executive director, with the approval of the board of trustees, shall appoint the director of the quality assurance division. The executive director may, with like approval, remove said director.
(b) The quality assurance director, subject to the direction, control and supervision of the executive director, shall be responsible for:
(1) In consultation with the consumer, professional and health care organizations advisory councils, studying the utilization patterns of all health care providers and health care organizations and the quality of the services they provide. In fulfilling this responsibility, the quality assurance division shall investigate all situations of possible billing fraud by individuals or institutions and investigate providers whose patterns of billing are inconsistent with the guidelines developed by the trust for the treatment of specific illnesses.
(2) In consultation with the consumer advisory council, investigating consumer fraud that results from accessing the Connecticut health care system illegally.
(3) Certifying, licensing and recertifying all health care providers, health care organizations and medical laboratories in this state. (4) To approve or reject any proposed health care capital expenditure within Connecticut in excess of five hundred thousand dollars;
(5) In consultation with the consumer, professional and health care organizations advisory councils, responding to complaints on the part of consumers, health care providers and health care organizations concerning inadequate, unprofessional, impaired or prejudicial treatment on the part of a health care provider or health care organization.
(6) In consultation with the consumer, professional and health care organizations advisory councils, instituting reeducation, treatment, supervision requirements and restricting or terminating the licensure of health care providers or institutions that are found to be deficient in their quality or manner of providing health care.
(7) In consultation with the consumer and professional advisory councils, establishing and enforcing continuing education requirements for specified licensed health care workers in this state.
(8) In consultation with the consumer advisory council, responding to and arbitrating disagreements between providers and consumers or providers and the state concerning eligibility for reimbursement under the Connecticut health care system or any other disagreement the director deems worthy of arbitration.
(9) In consultation with the consumer and health care organizations advisory councils, establishing procedures for enforcing standards of care and staffing.
Sec. 9. (NEW) (a) There shall be a consumer division within the Connecticut Health Care Trust which shall be under the supervision and control of a director. The director of the consumer division shall be appointed by the executive director of the trust with the approval of the board of trustees, and may be removed by the executive director with the approval of the board of trustees.
(b) The consumer division director shall, subject to the direction, control and supervision of the executive director, be responsible for:
(1) Establishing a reasonable number of regional offices located throughout the state. Each office shall be staffed to respond to questions and complaints from consumers and providers, to perform local outreach and informational functions and to hold hearings to determine unmet health care needs in consultation with the consumer advisory council.
(2) To promote preventative and ameliorative public health among the residents of the state of Connecticut through education and the establishment of consumer groups to promote healthy behavior in consultation with the consumer advisory council.
Sec 10. (NEW) (a) There shall be a service division of the Connecticut health Care Trust which shall be under the supervision of a director. The director of the service division shall be appointed by the executive director with the approval of the board of trustees, and may be removed by the executive director with the approval of said board. (b) Subject to the direction, control and supervision of the executive director, the director of service shall be responsible for: (1)Administering any and all direct services provided by the Trust to the residents of the State of Connecticut. (2) Seeking ways to minimize the direct services of the Trust by outsourcing these services or providing these services through certified, free-standing, not for profit health care organizations. (c)At such time, if any, that the Trust no longer operates any direct services, the service division of the trust shall be terminated. Sec. 11. (NEW) (a) There shall be a state-wide consumer advisory council for the trust, which shall consist of twelve members. The Governor shall make appointments to the advisory council from nominations provided by organizations that have been supporting or advocating a universal health care system on or before January 1, 1995. Eligible organizations shall submit nominees to the Governor not later than one month after the effective date of this act, or within one month of a vacancy on the council due to resignation, removal or completion of term. There shall be at least twenty nominations for these twelve appointments. The Governor shall make appointments from the list of recommendations within two months of receiving such nominations. In making appointments, the Governor shall consider geographic and demographic diversity.
(b) Each member shall serve a term of five years, provided in making the initial appointments, four members shall serve three-year terms, four members shall serve four-year terms and four members shall serve five-year terms. The length of term for the initial appointments shall be determined by the Governor within the designated distribution of terms. Any person appointed to fill a vacancy on the advisory council shall serve for only the unexpired term of the member such person replaces. Any member shall be eligible for reappointment. Any member may be removed by the Governor for cause. Seven members shall constitute a quorum and the affirmative vote of a majority of council members present and eligible to vote at a meeting shall be necessary for any action to be taken by the advisory council. The members shall annually elect a chairperson who will serve on the board of trustees of the Trust.
(c) The state-wide consumer advisory council shall serve as an independent oversight body, which shall:
(1) Work with the director of the planning, development and research division to make recommendations to the executive director concerning benefits packages and payment schedules for provider and health care organizations and capital expenditures;
(2) Work with the director of the consumer division to promote consumer education and healthy behavior among consumers;
(3) Work with the director of the quality assurance division to develop procedures and investigate professional providers and health care organizations that are not in compliance with the guidelines for the prevention and treatment of disease in the state of Connecticut or the staffing and quality of care standards established by the Connecticut health care system;
(4) Work with the director of the quality assurance division to develop procedures and investigate consumer fraud that results from accessing the Connecticut health care system illegally;
(5) Work with the director of the quality assurance division to develop and enforce continuing education requirements for health care providers in this state;
(6) Work with the director of the quality assurance division to assure that grievances by consumers, health care providers and health care organizations concerning the Connecticut health care system are appropriately investigated and resolved with recommended changes;
(7) Work with the director of the benefits division to assure that trust money is appropriately invested and timely and efficient payment mechanisms are utilized to pay health care providers and health care organizations. (8)Work with the director of the service division to assure that services are efficient, effective and appropriate. (9)Write an annual report summarizing its appraisal of the functioning of the Trust.
(d) The advisory council shall submit a budget proposal to the executive director, not to exceed five hundred thousand dollars, adjusted for inflation or deflation, each year and may alter said proposal from time to time throughout the year. The advisory council may expend its budget in whatever manner it determines best serves the interests of health care consumers and the Connecticut health care system, except for that portion, if any, which is to be utilized to compensate members for their work in overseeing the trust above and beyond reimbursement for actual and necessary expenses for the performance of the members duties. Any such revenue shall be on an hourly basis in an amount requiring the approval of the board of trustees. The executive director shall, from time to time, requisition from the trust such amounts as the executive director deems necessary to meet the current obligations of the advisory council, provided such amounts shall not exceed, in the aggregate, five hundred thousand dollars per year, adjusted for inflation or deflation.
Sec. 12. (NEW) (a) There is hereby created a state-wide professional advisory council which shall work with the director of planning, development and research of the Connecticut Health Care Trust to:
(1) Recommend to the executive director consensus guidelines to be used by health care providers for the treatment and prevention of illness in the state of Connecticut.
(2) Recommend to the executive director a benefits package for residents of the state of Connecticut, which shall be administered by the trust.
(3) Recommend to the executive director fee schedules for procedures covered under the benefits package.
(b) The professional advisory council shall work with the director of the quality assurance division of the trust to:
(1) Recommend to the executive director a method for evaluating the compliance of health care professionals with the consensus guidelines for the treatment and prevention of disease in the state of Connecticut.
(2) Recommend to the executive director appropriate consequences for health care professionals who fail to comply with the consensus guidelines for the treatment and prevention of disease in the State of Connecticut.
(c) The professional advisory council shall work with the director of the benefits division to develop information management systems and insure timely payment to health care providers.
(d) The professional advisory council shall consist of one member from each licensed category of health care professionals, except physicians, to be elected or appointed by their state-wide professional organizations for two to five-year terms at the discretion of the state-wide professional organizations and seven physicians elected or appointed by the Connecticut State Medical Society, one of whom shall represent primary care physicians, one of whom shall represent pediatricians, one of whom shall represent internal medicine specialists, one of whom shall represent obstetricians and gynecologists, one of whom shall represent surgeons, one of whom shall represent psychiatrists and one of whom shall represent other physician specialists. The members shall annually select a chairperson who shall serve on the board of trustees.
(e) Each council member shall serve without compensation from the trust, but shall be reimbursed for actual and necessary expenses incurred in the performance of the member's duties. Professional advisory council members may be compensated for their work by their respective professional organizations at the discretion of that organization.
Sec. 13. (NEW) (a) There is hereby created a state-wide health care organizations advisory council. The health care organizations advisory council shall be composed of one member of each category of health care organizations recognized by the state. These members shall be selected by their respective professional organizations.
(b) Members of the state-wide health care organizations advisory council shall be elected or appointed for two to five-year terms at the discretion of their respective professional organizations. Members shall serve without compensation from the trust, but shall be reimbursed for actual and necessary expenses incurred in the performance of the member's duties. Members of the health care organization advisory council may be reimbursed by their respective professional organizations for their services on the council at the discretion of their respective professional organizations. The members shall annually select a chairperson who shall serve on the board of trustees.
(c) The health care organizations advisory council shall work with the director of the planning, development and research division to:
(1) Make recommendations to the executive director concerning services and procedures offered by health care organizations which should be covered by the trust.
(2) Make recommendations to the executive director of the trust concerning payments to health care organizations for covered services.
(3) Make recommendations to the executive director concerning new capital expenditures in the state and the coordination or consolidation of health care services among health care organizations.
(4) Make recommendations to the executive director concerning means for evaluating, modifying and approving global budgets for health care organizations in the state. (5) Review, modify and approve global budgets for health care organizations in the state. (d)The health care organizations advisory council shall work with the director of the quality assurance division of the trust to:
(1) Make recommendations to the executive director of the trust concerning methods for evaluating the compliance of health care organizations with the guidelines for the treatment and prevention of illness adopted by the trust.
(2) Make recommendations to the executive director concerning appropriate consequences to those health care organizations that are not in compliance with the guidelines for the treatment and prevention of illness adopted by the trust.
(3) Make recommendations to the executive director of the trust concerning standards of care and staffing requirements.
Sec. 14. (NEW) Any Connecticut resident who meets the following requirements shall be eligible for covered services under the Connecticut health care system:
(1) Any person (A) who has been a legal resident of this state for at least one year, (B) whose employer has paid all health care trust fund premium payroll taxes for such person for at least six months, (C) who has paid all self-employment health care trust fund premium taxes for a period of at least six months, or (D) who is the dependent of a person who meets the requirements of subparagraphs (A), (B) or (C) of this subdivision.
(2) A Connecticut resident eligible for benefits under this section is further eligible for long-term care upon showing any of the following: (A) That such resident is and has been employed full-time for two years, or a correspondingly greater number of months of part-time employment, by an employer who has for the entire time made all required payments to the trust; (B) resided in Connecticut and made all required payments of personal and payroll health taxes to the trust for a period of two years; (C) is entitled under federal laws to such benefits; or (D) has for two years been a dependent of an eligible Connecticut resident.
(3) Any individual who is not eligible for long-term care under the provisions of subdivision (2) of this section shall be eligible for long-term care to the same extent and under the same condition as such individual would have been under any program existing prior to the effective date of this act.
Sec. 15. (NEW) Initial funding for the Connecticut Health Care Trust shall be provided from funds received by the state from the Master Settlement Agreement executed November 23, 1998. Such funds shall be used by the trust to:
(1) Establish and carry out the functions of the trust as provided in this act until such time that the benefits provided for by this act can be initiated, not to exceed two years. This provision shall specifically include the development of information systems to facilitate billing and payment, outcome studies and utilization review, as well as the development of guidelines for the treatment and prevention of specific illnesses, the establishment of a benefits package and a payment schedule for providers and institutions with regard to procedures which will be covered by the benefits package.
(2) Educate providers and consumers about the Connecticut health care system.
(3) Establish enrollment in the Connecticut health care system.
(4) Accomplish baseline studies on the current Connecticut health care system in terms of its cost and effectiveness.
(5) Make a recommendation to the General Assembly concerning an initial budget and appropriate sources of funding.
(6) Invest unutilized funds in a manner consistent with state policy.
(7) Obtain grants from the federal government and other funding sources to help establish the Connecticut Health Care Trust and study its cost and effectiveness.
(8) Seek all necessary waivers, exemptions, agreements or legislation, so all current federal and state payments for health care shall be paid directly to the trust at the starting date of the trust, which shall then assume responsibility for all benefits and services previously paid for by such federal and state payments for health care.
(9) Establish provisions for the retraining and assistance in finding suitable employment for those insurance and health care workers who are displaced by the enactment of the benefits package of the trust. Provisions for such retraining and assistance shall be made in the initial budget, not to exceed one per cent of such initial budget, and shall be considered in subsequent budgets up to three years after the beginning of the trust. (10) Develop an organizational structure for the trust that includes capital equipment and personnel required to carry out the functions of the trust.
Sec. 16. (NEW) (a) There is hereby established the Connecticut Health Care Trust Fund. All money transferred into the Connecticut Health Care Trust Fund shall be considered property of the Trust and not part of the State of Connecticut’s General Fund. Funding for the Connecticut Health Care Trust Fund shall be obtained from the following sources:
(1) The Connecticut Health Care Trust shall seek to maximize all sources of federal financial support for health care services in this state. The executive director of the trust shall obtain waivers, exemptions or legislation, if needed, so that all current federal payments for health care, including Medicare, Medicaid, Veterans and Title XXI funds, as well as health insurance premium funds for federal employees and their families shall be paid directly to the fund.
(2) The state of Connecticut shall pay into the fund the moneys it currently pays for those health care services, administrative service, and any and all functions assumed by the trust as defined in Sec. 17 of this Act. The total appropriation for these health and administrative services shall be altered yearly through negotiations between the executive director of the trust, the Governor and the General Assembly.
(3) Taxes shall be imposed on items that contribute to increased health care expenditures. Surtaxes, to be determined by the executive director of the trust, subject to the approval of the General Assembly, are imposed on tobacco products, alcohol, firearms, gasoline, motor vehicles and facilities operating in the state of Connecticut that generate materials that causes or contributes to illness among Connecticut residents. These products and facilities may be taxed to the extent that they can be reasonably determined to contribute to the health care costs of the residents of the state of Connecticut.
(4) All employers shall pay a trust fund premium, based on their payroll, starting with the enactment of the benefit plan of the trust, as determined by the trust and the Department of Revenue Services. The amount of this premium shall be determined by the executive director of the trust in consultation with the Department of Revenue Services subject to the approval of the General Assembly. For corporations with more than 100 employees who currently provide health insurance benefits to their employees, this premium shall be in line with, or less than, the average contribution that such employers make toward employee health benefits, including medical benefits through workman’s compensation, as of the effective date of this act.
(5) Families or individuals receiving covered benefits under the Connecticut health care system shall contribute premiums on a scale as determined by the trust in consultation with the Department of Revenue Services subject to the approval of the General Assembly. The premium shall be collected through the current state income tax system. There shall be no premiums for families of individuals with income below one hundred and eighty-five per cent of federal poverty level guidelines. Premiums shall be set so that the cost for the average self-employed family in Connecticut shall be less than the cost of comparable private insurance for the benefit package insured by the trust. Premiums for those Connecticut residents eligible for federally funded health care programs shall be taxed at a rate so that the cost of their premiums for the average federally funded beneficiary shall be less than the cost of private insurance to cover those services which are benefits of the trust but not of the federal program and any or all copayments those federally funded programs may require. Premiums for those Connecticut residents eligible for employer based health care programs shall be taxed at a rate so that the cost of their premiums for the average employer based health insurance recipient shall be less than the cost of private insurance to cover those services which are benefits of the trust but not of typical employer based health insurance programs and any or all copayments or contributions those employer based programs may require.
(6) The trust shall seek grants from all appropriate and available sources to fund research and administration relevant to the Connecticut health care system.
(7) The trust shall retain: (A) Any charitable donations, gifts, grants or bequests made to it from whatever source consistent with state and federal laws; (B) any rebates negotiated or established; and (C) income from the investment of trust assets, including any remainder from the state tobacco settlement, consistent with state law.
(8) Any additional funds the state of Connecticut shall distribute to the trust through a general appropriation enacted by the General Assembly in response to a funding request by the executive director of the trust.
(b) Amounts credited to the fund shall be used for the following purposes:
(1) To reimburse eligible health care providers and health care facilities for covered services rendered to eligible patients;
(2) To pay for preventative educational and outreach programs, as well as related health care activities, not to exceed three per cent of the trust income in any fiscal year;
(3) To supplement other sources of financing for approved capital investments in excess of five hundred million dollars for eligible health care providers and facilities, not to exceed three per cent of trust income in any fiscal year;
(4) To fund training and retraining programs for workers in the health care sector displaced as a result of administrative streamlining gained by moving from a multipayer to a single payer health care system, not to exceed one per cent of trust income in any fiscal year provided, such funding shall terminate June thirtieth of the third year following full implementation of this act;
(5) To fund a reserve account to finance potential budgetary shortfalls, epidemics and other extraordinary events, not to exceed more than one per cent of the trust income in the past fiscal year;
(6) To pay for the benefits division of the trust, not to exceed three per cent of trust income in any fiscal year;
(7) To pay for the general administration of the trust, including the office of the executive director and the divisions of planning, development and research and quality assurance, not to exceed three per cent of trust income in any fiscal year, not including moneys transferred to the trust from the state of Connecticut to fund those quality assurance activities that will be taken over by the trust which were previously carried out by the Department of Public Health or other agencies of state government;
(8) To pay the administrative costs of the state-wide consumer advisory council, not to exceed five hundred thousand dollars in any fiscal year, adjusted for inflation or deflation;
(9) To pay the administrative costs of the professional advisory council, including the reimbursement of professional advisory council members for actual and necessary expenses incurred in performing their duties, not to exceed one hundred thousand dollars in any fiscal year, adjusted for inflation or deflation; and
(10) To pay the administrative costs of the health care organizations advisory council, including the reimbursement of the health care organizations advisory council members for actual and necessary expenses incurred in performing their duties, not to exceed one hundred thousand dollars in any fiscal year, adjusted for inflation or deflation. (11) To pay for the service division of the Trust. (12) To reimburse members of the board of trustees for actual and necessary expenses incurred in performing their board duties not to exceed one hundred thousand dollars in any fiscal year, adjusted for inflation or deflation. (c) Unexpended trust assets shall not be deemed to be surplus funds, but shall be retained in the fund for investment purposes. These funds shall be addressed and accounted for in determining appropriate funding for the trust. Sec. 17. (New) (a) The statutory public health functions and obligations of any and all State of Connecticut Departments, Boards, Offices or agencies which are being assumed by the Trust under this Act shall be terminated and transferred to the Trust. There shall be no duplication of services. The functions and obligations transferred to the Trust shall specifically include those of : (1)the health insurance fraud unit of the Connecticut Insurance Department, (2)the Department of Mental Health and Addiction Services, (3)the Department of Public Health, (4) the Department of Mental Retardation, (5) the Office of Health Care Access, (6)the Medical Assistance and Husky Plan divisions of the Connecticut Department of Social Services, as well as the Connecticut Pharmaceutical Assistance Contract to the Elderly, the Maternal and Child Health Services, and the DMHAS programs of the Department of Social Services, (7) the substance abuse services, the mental health services and the medical/health services, and wilderness school of the Department of Children and Families, (8) the medical service component of the Department of Veteran’s Affairs (9) the medical service component of the Workman’s Compensation Commission and (10) the Health Fraud Bureau of the Division of Criminal Justice. (b) The Children’s Protective and Family Services of the Department of Children and Families shall be moved to the Department of Social Services; the Juvenile Justice Services of the Department of Children’s and Families shall be moved to the Division of Criminal Justice, and the Department of Children and Families shall be terminated. (c) The Department of Mental Health and Addiction Services, the Department of Public Health, the Department of Mental Retardation and the Office of Health Care Access shall be terminated. (d) Sec.31-279 of the Workers’ Compensation Act shall be rescinded. (e) Funding for the state programs and statutory obligations assumed by the Trust of existing state departments, boards, offices and agencies shall be transferred to the Trust and continue to be funded by the State of Connecticut at budgetary levels negotiated yearly between the Governor and the executive director of the Trust subject to approval by the General Assembly. (f) All building space, material possessions, property, and electronic devices utilized by any and all of the offices, departments, boards and agencies assumed by the Trust shall be made available to the Trust for its use but remain the property of the State of Connecticut. (g) The Trust shall be free to terminate or reorganize any and all state programs and functions transferred to the Trust, including the termination of employees of these state departments, programs, offices and agencies, as long as the Trust continues to meet statutory functional requirements. (h) If it is deemed appropriate by the Trust, state employees who have been employed by state programs assumed by the Trust under this Act shall be transferred into the Trust and remain as state employees or become trust employees at the discretion of said employees. (i) New employees of the Trust shall not be considered state employees, but employees of the Trust. (j) The Trust shall not assume any responsibility for the University of Connecticut Medical Center, but will pay for medical services rendered through the University of Connecticut Medical Center in accord with the same procedures utilized in paying for the medical services rendered by any and all other Connecticut hospitals, organizations or licensed health care professionals providing health care services for those residents of the State of Connecticut covered by this Act.

This act was written by John R. Battista, M.D. and Justine A. McCabe, Ph.D. in conjunction with individual and organizational members of the Connecticut Coalition For Universal Health Care. Comments, critiques and suggestions for revision are welcomed. Drs. Battista and McCabe can be reached by phone at (860) 354-1822, by fax at (860) 355-9995, by email at riverbnd@javanet.com, or by mail at 88 Cherniske Road, New Milford, CT 06776.